The institutions (particularly public) charge whatever they can get. I will be happy to scan and send copies of my "courtesy" bills from UCSF if anyone wishes or doubts -email me privately. I was told, informally that my HMO didn't pay anywhere near that amount because they have a "deal" with the CCC. It might indeed have been closer to RileyMC's numbers. Most costs of everything are based on some degree on the region where you live. San Francisco is one of the most expensive places to live in North America. There was an article in this mornings paper of what a million dollar house is in the SF Bay Area today. This can range from a 1920's, 2,026 sq ft house in Oakland to a 1,510 sq ft 1955 tract house in San Mateo (what used to be considered "middle class" residences). In Portland 1 million will buy you a brand new 3,533 ft home with 3 br, 3 bath, in Houston it will buy you a 2005, 6,413 sq ft house w/5 bedrooms and 4.5 baths, in Madison WI, a 1997 5,287 sq ft with 4 br and 2.5 baths. Manhattan has us beat 1 million will buy you a 2006, 1 bedroom, 2 bath, 1,021 sq ft.